This is a program that I am really excited about, partly because I like to think that I am an athlete. I believe that this program can really make a significant difference in the fine-tuning and longevity of the competitive athlete. The nutritional misconceptions among sports people are great, and the diets, protein concoctions, and vitamins they are taking may even be dangerous.

Although there may be some differences between the body builder and the marathon runner, they are both required to push their bodies to the limit. Increased activity levels, sweating, and tissue wear and tear mean a need for special support. Any intelligent athlete also should know how important it is to balance workouts with proper stretching exercises to maintain flexibility, and with toning exercises as well as some aerobic activity for cardiovascular health. Aerobic exercise—continuous, repetitive movement of large muscle groups (legs or whole body) for more than 10–15 minutes—uses oxygen more efficiently, plus it burns fat. Our maximum aerobic exercise heart rate (calculated simply) is 220 minus our age. Depending upon our physical state, we will usually exercise at a range from 70–85 percent of our maximum.

A concern I see in my practice is the "ex-athlete," such as the college jock who was in training for years on a special high-protein, high-fat diet. Such people usually handle this type of diet well enough in their early years because of the high amount of exercise they did. However, when they entered the work world instead of professional sports and changed their lifestyle but not their diet, they gained weight and clogged their arteries. This is also true for retired sports professionals. Changes in activity levels require changes in diet, both total calories and types of food eaten. Such people need to keep exercising as well as change their diets to reduce the chances of early death from cardiovascular disease. No one should ever really become an ex-athlete anyway; exercise is for life. It represents a commitment to health.

One of the big problems with athletes is that regular training and vigorous workouts allow them to get along with the worst kind of diet. The body uses up everything and needs more. Exercise is as important as or more important than a good diet, but implementing both together is the optimum; this duo is the best plan for weight reduction and maintenance. Regular exercise improves metabolism and calorie/nutrient use, reduces cardiovascular disease risk, osteoporosis and diabetic risks, while it improves oxygenation and psychological attitude. Competitive or professional athletes also require a balanced exercise program supported by proper nutrition.

Athletics is affected by a lot of nutritional controversies, and it may be hard for athletes to know what is good for them. High-protein diets, lots of meat, protein powders, salt tablets, special vitamin pills, and now carbohydrate loading to prepare for endurance and competitive efforts—these are just a few of the topics. I do not support high-protein diets or protein powders, although in some cases these may be helpful. People in active training do have some increased protein needs, but too much animal protein and powders can stress the kidneys and contribute to toxic metabolic products in the colon and body.

Salt tablets are almost always unnecessary—water and high-nutrient foods and occasional salted snacks will replace what is needed. Potassium and magnesium are needed as much as or more than sodium chloride. High-fat diets are also contraindicated. Muscles need glycogen (a carbohydrate) for their fuel, and carbohydrates give us the sustained energy we need for athletic activity. Thus, a basic complex-carbohydrate diet is the healthiest focus, with some added special dimensions for training.

Regular vigorous exercise obviously increases our demands for most everything, particularly calories and nutrients. Exercise improves our elimination and our metabolism, which means we need to nourish ourselves regularly. Physical exercise is also a stressor that may increase free-radical formation, so that additional antioxidant nutrients may be required. The physical stresses of vigorous exercise may also cause tissue irritation and breakdown, which we can counteract with natural anti-inflammatories, such as vitamins E and C and bromelain enzyme, and with amino acids to build up the tissues again. Regular sweating also causes the loss of many nutrients, particularly water, Vitamin B1, and some minerals—sodium, potassium, chloride, and magnesium are probably the most significant.

If all of these processes and nutrients are not balanced, nutritional deficiencies may result. Then, injuries can occur more easily, bone or muscle loss or breakdown may result, and this can all interfere with athletic performance. We prevent injuries with proper care in nutrition, adequate stretching and warm-ups, proper cool-downs, and adequate liquid intake. In the competitive world, the slightest changes may make a great difference—sometimes the difference between losing and winning. For professional athletes, of course, this could affect their livelihood.

Diet for the athlete in training and/or for performance is centered on the complex carbohydrates—whole grains and their products, such as pasta, legumes, potatoes and other starchy vegetables—along with some good-quality vegetable and/or animal protein, fruits, and a low-to-moderate fat intake. Athletes, like everyone else, need a well-balanced diet with a high nutrient intake. The increased activity generates the need for a higher amount of calories, protein, and other nutrients than the less active person requires. For weight control or maintenance, we need to vary our calorie intake with our activity level. When the season is over or we take time off or just stop exercising for some reason, we need to change our diet and consume less calories, fats, and proteins.

A high-fat diet is definitely out for athletes. It slows them down and can increase the body fat percentage, something that is taboo for the active athlete. For many of us, the fatty flavor of foods is the more addictive aspect of the diet, and with any lessening of physical activity, the higher-fat foods will clog the blood vessels and increase cholesterol and heart disease risk. Athletes should definitely avoid fried foods, high-fat meals, lunch meats, bacon, ham, and any foods cooked in animal fats. The higher-protein, lower-fat foods such as fish and poultry are better than the red meats. Some nuts and seeds, high in essential oils and protein, can be used as well.

Protein is very important for athletes, but the subject of how much and which proteins are best needs a lot of clarification. Protein intake in general should be less of a focus in the diet. Excess protein intake can produce certain minor problems, including clogging of the colon and stress on the kidneys. More protein than is needed for tissue building and its other functions merely gets used for energy or must be eliminated. The complex carbohydrates, though, are used much more efficiently for energy needs or for storage for later use. So, for best efficiency and performance, I believe that a diet based on complex carbohydrates with adequate, but not excess, protein is ideal.

Athletes (and regular exercisers), however, do need some extra protein with increased activity, but it should be increased in proportion to calories. People who are trying to gain weight, those wanting to build muscle, or those in heavy training do need additional protein, sometimes up to 150–200 grams daily, to stay in positive protein balance, especially when the calorie intake goes up near 3,000 a day. Some protein powders and amino acid formulas can be used to augment the protein balance. Aerobic-type exercises may slightly increase protein needs but not as much as body-building activities. Some extra protein intake, still along with a high-complex-carbohydrate, low-fat diet, will support muscle bulk while maintaining body fat levels. Young athletes need even more good protein foods than adults but should still focus on the complex carbohydrates for proper development. Again, avoid high-protein diets that exclude other important foods, particularly the complex carbohydrates, fruits, and vegetables. For building muscle, it may be better in many cases (especially when extra calories are not needed) to use good-quality supplemental amino acids or protein hydrolysates containing peptides to provide the cells and tissues with what they need to build and repair, rather than eating an excess of heavier flesh food proteins.

Complex carbohydrates provide the sustaining long-term energy, proteins the tissue building, and fats the lubrication and tissue support. This type of diet is also high in fiber, which allows good elimination. It is wise for serious athletes and health-conscious people to avoid excessive use of alcohol, regular cigarette smoking, and stimulants such as caffeine in coffee, tea, and cola beverages. Some iron-rich foods are especially important for female athletes or active runners, as their red blood cells may be broken down more rapidly. High-iron foods include red meats and liver (organic only), shellfish such as oysters, leafy greens, prunes, and mushrooms. With anemia, higher doses of supplemental iron may be needed.

Carbohydrate loading is a fairly new concept in the athletic world. It is based on the fact that complex carbohydrates such as grains, pastas, pancakes, and whole grain breads increase available energy, improving the stamina and ability to work. Here is how carbohydrate loading works. Four or five days before an endurance-type event, we increase our exercise and reduce our complex carbohydrate intake to about 40–50 percent of our diet, and eat more protein, fats such as dairy products and eggs, and fruit. This depletes the glycogen in our muscles and liver. Then, two to three days before the event, we increase complex carbohydrates to 70–75 percent of our diet, eating at least three big meals of carbohydrates, plus some proteins and fats. This increases the stored glycogen in the liver and muscles. Glycogen, the storage form of glucose, is easily converted to the simple sugar that is used by all cells and tissues for energy. Glycogen is then burned first for energy; if more energy is needed, fat will be utilized, and that works well too. If there is very low body fat, proteins in tissues may also be converted to energy. All of these macronutrients will need to be replaced. Some athletes report that carbohydrate loading increases sexual energy too. For any athletes with fatigue, carbohydrates will often help. Adding more grains, pasta, cereals, breads, vegetables, and fruit may also add strength and endurance.

10–20 percent simple—fruits, most vegetables, and any special "treats"

40–50 percent complex—whole grains, legumes, starchy vegetables

Proteins—15–20 percent (maximum 25 percent)

animal—fish, poultry, meats, eggs, dairy

vegetable—nuts, seeds, legumes

Fats—25–30 percent

saturated—meats, eggs, dairy products

unsaturated (more than half)—nuts, seeds, vegetable oils, avocado

One of the biggest nutrient concerns in athletes is water depletion. With heavy training, be it strenuous or extensive activity, large water losses can occur, and drinking water is the only way to remedy this. Long endurance events also increase the need for fluids. Any activity where sweating occurs sets up an even higher requirement for water than the usual one and a half or two quarts per day. Water, which should be our main liquid, has many essential functions. It supports the whole process of sweating and elimination of toxins, it nourishes the skin and other tissues, and it is the medium in which our blood cells circulate and everything in our body lives. Dehydration from low fluid intake leads to weakened tissue perfusion (circulation of blood with oxygen and nutrients), fatigue, and poor performance.

Elson M. Haas, MD is founder & Director of the Preventive Medical Center of Marin (since 1984), an Integrated Health Care Facility in San Rafael, CA and author of many books on Health and Nutrition, including ...more

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